Predicting Adverse Pregnancy Outcomes based on Maternal Serum Markers in Quad Test

Morakot Suwanwanich

Authors

Morakot Suwanwanich Department of Obstetrics and Gynecology, Ratchaburi Hospital, Thailand https://orcid.org/0000-0002-6749-1604

Keywords:

quad test, maternal serum marker, adverse pregnancy outcome

Abstract

Objective To compare adverse pregnancy outcomes (APOs) between low-risk and high-risk serum quadruple test for aneuploidy screening.

Methods This cohort design study screened pregnant women who had undergone quad test serum screening in Ratchaburi province, Thailand. The sample of 400 women was divided into two groups, low-risk quad test (n=200) and high-risk quad test (n=200) using random allocation software. Participants were followed up for final outcomes and compared for APOs. The data were analyzed using binary logistic regression analysis and risk ratios.

Results Of a total of 1,891 pregnant women, 206 (10.8%) had APOs. Of the women with APOs, 92 (46%) had high-risk quad test results and 32 (16%) were in the low-risk quad test group. The incidence of preeclampsia, intrauterine growth restriction (IUGR) and chromosome abnormality in the high-risk quad test group were all statistically significantly higher in the high-risk quad test group than in the low-risk quad test group (p = 0.013, 0.001, 0.043 respectively). The high-risk quad test group also had a higher incidence of preterm birth, abortion, gestational diabetic mellitus in high-risk quad test group, but the differences were non-statistically significant.

Conclusions High-risk serum quad test results can help predict the risk of APOs such as preeclampsia, IUGR and chromosome abnormality.

References

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams obstetrics. 25th ed. New York: McGraw-Hill Education; 2018.

Jung A, Hyun Ji, Yeon Y. Introduction of a nomogram for predicting adverse pregnancy outcomes based on maternal serum markers in the quad screen test. Arch Gynecol Obstet. 2015;292:589-94.

Dinc K, Ozyurt R. Effects of secondary trimester maternal serum screening on the results of pregnancy, J Human Sciences. 2017;14:3653-62.

Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med. 2017;45:817-20.

Gaccioli F, Aye ILMH, Sovio U, Charnock Jones DS, Smith GCS. Screening for fetal growth restriction using fetal biometry combined with maternal biomarkers. Am J Obstet Gynecol. 2018;218:S725-37.

Basbug D, Basbug A, Gulerman C. Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome? Ginekol Pol. 2017;88:325-30.

Dugoff L. Society for Maternal-Fetal Medicine. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol. 2010;115:1052-61.

Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol. 2020;135:1492-95.

Cohen JL, Smilen KE, Bianco AT, Moshier EL, Ferrara LA, Stone JL. Predictive value of combined serum biomarkers for adverse pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol. 2014;181:89-94.

Sirikunalai P, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, et al. Associations between maternal serum free beta human chorionic gonadotropin (beta-hCG) levels and adverse pregnancy outcomes. J Obstet Gynaecol. 2016;36:178-82.

Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30:918-49.

Ranta, JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Decreased PAPP-A is associated with preeclampsia, premature delivery and small for gestational age infants but not with placental abruption. Eur J Obstet Gynecol Reprod Biol. 2011;157:48-52.

Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Riet GT, et al. Serum screening with Down’s syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2008;8:33-8.

Mikat B, Zeller A, Scherag A, Drommelschmidt K, Kimmig R, Schmidt M. hCG and PAPP-A in first trimester: Predictive factors for preeclampsia? Hypertens Pregnancy. 2012;32:261-7.

Sayin NC, Canda MT, Ahmet N, Arda S, Süt N, Varol FG. The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet. 2008;277:47-53.

Kwon JY, Park IY, Kwon SM, Kim CJ, Shin JC. The quadruple test for Down syndrome screening in pregnant women of advanced maternal age. Arch Gynecol Obstet. 2012;285:629-33.

Huang T, Hoffman B, Meschino W, Kingdom J, Okun N. Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome. Prenat Diagn. 2010; 30:471-7.

Towner D, Gandhi S, El Kady D. Obstetric outcomes in women with elevated maternal serum human chorionic gonadotropin. Am J Obstet Gynecol. 2006; 194:1676-82.

Allouche M, Huissoud C, Guyard-Boileau B, Rouzier R, Parant O. Development and validation of nomograms for predicting preterm delivery. Am J Obstet Gynecol. 2011;204:242.e1-242.e8.

Boonpiam R, Wanapirak C, Sirichotiyakul S, Sekararithi R, Traisrisilp K, Tongsong T. Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: a population- based study. BMC Pregnancy and Childbirth. 2020; 20:621-9.